Background: Powassan virus is a cause of viral encephalitis transmitted by Ixodes ticks. A few weeks following a tick bite, patients with Powassan virus infection present with fever, encephalitis, disorientation, or aseptic meningitis. Ten percent of cases are fatal, and 50% of survivors experience long-term neurological sequelae. The diagnosis of Powassan virus is primarily based on serology; however, significant cross-reactivity exists with other flaviviruses. Testing is primarily by serology. Powassan virus polymerase chain reaction can be performed on cerebrospinal fluid, but the virus is rarely detectable by the time patients present with symptoms. Methods: This was a retrospective chart review of a single case of a woman with Powassan virus infection presenting with ascending paralysis. Results: We describe a 73-year-old woman who developed ascending paralysis following a tick bite in Southern Manitoba in June 2025. A Powassan virus plaque reduction neutralization test performed on patient sera that was positive, with a titre of 1:640. Conclusion: While Powassan virus cases have historically been rare in Canada, there has been a significant increase in recent years, particularly in Ontario and Quebec. The first case of Powassan virus in Manitoba was only reported in 2022, and this is the third case now known to be acquired in Manitoba. Powassan virus was made a nationally notifiable disease in 2024. Clinicians should be aware of the increasing incidence of Powassan virus infection in Canada, including its appearance in the Canadian prairies, as well as unusual presentations of infection, including ascending paralysis and rhombencephalitis.
Candida species are among the most common oral fungal pathogens. Oral Candida infection may obscure the presence of tongue cancer, resulting in delayed diagnosis. Retrospective clinical case review. A 59-year-old man had a white plaque on the left ventral surface of his tongue, noted during a routine dental visit. The plaque was painless and could not be removed by scraping. An incisional biopsy specimen showed hyperplastic candidiasis, and Candida albicans was recovered in culture. The plaque did not resolve despite antifungal treatment. A repeat tongue biopsy at 14 months after the initial biopsy showed mild to moderate epithelial dysplasia and papillary squamous cell carcinoma without invasion (squamous cell carcinoma in situ). Treatment included surgical excision of the carcinoma with wide margins. Follow-up at 7 years showed no recurrence. This case suggests that a high index of suspicion for malignancy is warranted in patients with oral candidal lesions that persist beyond 14 days of systemic antifungal therapy. Close monitoring and repeat biopsy may help minimize delays in cancer diagnosis and treatment.
Background:Annual influenza vaccination is recommended for solid organ transplant (SOT) recipients, with various strategies explored to enhance efficacy. Given the ongoing uncertainty about the benefits and potential risks of different strategies in influenza vaccination in SOT recipients, comparing the indirect comparisons of the available evidence is necessary. Methods:We searched MEDLINE, Embase, CENTRAL, and CINAHL from inception to March 2025 to identify randomized controlled trials that compared different influenza vaccinations in SOT recipients. We conducted a network meta-analysis and used the GRADE approach to assess the certainty of evidence, categorize interventions, and present the findings. The protocol for this systematic review was registered in PROSPERO (CRD42024537277). Results:A total of 13 articles met our eligibility criteria (with 2,298 participants) and assessed 10 vaccination strategies. The high-dose (60IMSD) influenza vaccine was superior to the standard influenza vaccination regarding the seroconversion rate for H1N1 (RR 2.27, 95% CI 1.52 to 3.39; high certainty) and H3N2 (RR 1.61, 95% CI 1.34 to 1.94; high certainty). All of the included vaccination strategies might have no difference in graft rejection and other adverse events compared with the standard vaccination. Conclusions:We found that the 60IMSD vaccine demonstrated better immunogenicity outcomes compared with all other influenza vaccines studied in SOT recipients. Additionally, we observed little or no difference among various influenza vaccination strategies in terms of graft rejection and other serious adverse events (SAEs) or non-serious adverse events (non-SAEs).
Background: Syphilis cases have been on the rise in Canada, and rapid point-of-care test (POCT) options may aid in timely diagnosis and treatment, thereby preventing further spread of infection. This study provides a laboratory evaluation of the performance of the MedMira Multiplo Complete Syphilis (TP/nTP) Antibody Test in comparison with the current conventional testing methods.Methods: Two operators independently performed testing in a blinded manner using 130 paired serum and simulated blood specimens, with the results compared with the corresponding known conventional syphilis serology test results.Results: Overall, among specimens known to be CMIA-positive and RPR-reactive, with a titre >= 1:8, the sensitivity and specificity of the POCT when tested with sera were 97.5% and 70%, respectively, for operator 1, and 100% and 61.1%, respectively, for operator 2. With simulated blood specimens and the same criteria, the sensitivity and specificity of the POCT were 95.0% and 82.2%, respectively, for operator 1, and 100.0% and 74.4%, respectively, for operator 2.Conclusion: Further evaluation in the field is necessary to determine the performance and acceptability of this device in clinical settings. Historique : Les cas de syphilis sont en hausse au Canada, et des tests rapides au point de service (POCT) peuvent contribuer & agrave; un diagnostic et un traitement rapides, pr & eacute;venant ainsi la propagation de l'infection. La pr & eacute;sente & eacute;tude procure une & eacute;valuation en laboratoire du rendement du test complet de d & eacute;tection des anticorps contre la syphilis (TP/nTP) Multiplo de MedMira par rapport aux m & eacute;thodes d'analyse modernes habituelles.M & eacute;thodologie : Deux op & eacute;rateurs ind & eacute;pendants ont proc & eacute;d & eacute; & agrave; des tests & agrave; l'aveugle & agrave; l'aide de 130 & eacute;chantillons de s & eacute;rum et de sang simul & eacute; appari & eacute;s, puis ont compar & eacute; les r & eacute;sultats avec les r & eacute;sultats correspondants connus des analyses s & eacute;rologiques contre la syphilis habituelles.R & eacute;sultats : Dans l'ensemble, parmi les & eacute;chantillons dont le r & eacute;sultat & eacute;tait positif & agrave; la CMIA et r & eacute;actif au RPR et dont le titre & eacute;tait d'au moins 1:8, la sensibilit & eacute; et la sp & eacute;cificit & eacute; du POCT analys & eacute; dans le s & eacute;rum correspondaient & agrave; 97,5 % et 70 %, respectivement, pour l'op & eacute;rateur 1, et & agrave; 100 % et 61,1 %, respectivement, pour l'op & eacute;rateur 2. & Agrave; l'aide des & eacute;chantillons de sang simul & eacute;s et des m & ecirc;mes crit & egrave;res, la sensibilit & eacute; et la sp & eacute;cificit & eacute; du POCT s'& eacute;levaient & agrave; 95,0 % et 82,2 %, respectivement, pour l'op & eacute;rateur 1, et & agrave; 100,0 % et 74,4 %, respectivement, pour l'op & eacute;rateur 2.Conclusion : Une & eacute;valuation plus approfondie devra & ecirc;tre r & eacute;alis & eacute;e sur le terrain pour d & eacute;terminer le rendement et l'acceptabilit & eacute; de ce test en milieu clinique.
